Provider Demographics
NPI:1881665784
Name:ZIMMER, EDWARD P (MS, DC)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:P
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:MS, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9757 WESTPOINT DR STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3265
Mailing Address - Country:US
Mailing Address - Phone:317-813-1998
Mailing Address - Fax:317-813-1997
Practice Address - Street 1:9757 WESTPOINT DR STE 500
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3265
Practice Address - Country:US
Practice Address - Phone:317-813-1998
Practice Address - Fax:317-813-1997
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001814A111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000205171OtherBCBS LEGACY PIN
IN176710AMedicare PIN